Quality of care in VA health care system compares well to other settings

The VA health care system is America's largest integrated health care system, and provides comprehensive services to eligible US military veterans who have enrolled. But the quality of care delivered by VA has been a long-standing concern. The Veterans Access, Choice and Accountability Act of 2014 mandated an independent assessment of the health care capabilities and resources of the Veterans Health Administration.

Gidengil and her colleagues systematically reviewed 69 studies conducted in the past ten years that evaluated the quality of care provided by VA compared with other health care settings. The review updates and expands on a similar one conducted in 2009.

"Updating the results of the prior review up to 2015 is critically important given the ongoing interest in the quality of care provided by the Veterans Health Administration," explains Gidengil.

"The results show that, in terms of safety and effectiveness, VA facilities compare favorably with others," says Gidengil in summarizing the results. "Rates of surgical complications and availability of services had the least favorable results, but these results were mixed rather than consistently poor."

Twenty-two of the 34 studies on safety and 20 of the 24 studies focusing on effectiveness showed that the same if not better quality of care is provided in VA facilities. These studies took into account safety measures and best practices that aim to avoid the illness, injury or death of patients receiving care, such as complications after surgical procedures. There was nothing unfavorable in the death rate of VA patients undergoing surgery or those residing in VA nursing homes.

"Mortality rates have declined more quickly in Veteran Affairs health care settings over time than in non-VA settings," adds Gidengil.

In terms of effectiveness, VA facilities had similar or superior quality to non-VA facilities with respect to preventive, recommended, and end-of-life care, as well as managing medications. Outpatient care generally rated higher in VA facilities in terms of diabetes care and screening tests related to heart disease and cancer, for instance.

The research team notes that relatively few studies have been done so far to compare VA with non-VA care in terms of timeliness, equity, efficiency, and patient-centeredness, and that the quality of the available studies vary.